Stakeholder Opinions: Physician perception of biologics in autoimmune disease - Targeted detailing is the key to success

Published by: Datamonitor

Published: Mar. 4, 2009 - 137 Pages

Table of Contents

ABOUT DATAMONITOR HEALTHCARE

About the Immunology and Inflammation (I&I) pharmaceutical analysis team

CHAPTER 1 EXECUTIVE SUMMARY

Datamonitor insight into the autoimmune biologics market

Contributing experts

Related reports

Upcoming 2009 reports

CHAPTER 2 PHYSICIAN DYNAMICS AND QUESTIONNAIRE DESIGN

Physician types surveyed

Questionnaire design

Importance of attributes

Rating of brands

Physician demographics

Rheumatologists

Dermatologists

Gastroenterologists

CHAPTER 3 FACTORS INFLUENCING PHYSICIAN DECISION MAKING

Comparative importance of factors to the prescribing decision

Disease modification and side-effects are the most important factors to all prescribing physicians

Variation by country and physician type

Little variation seen between physician type

The UK and US show commonality while Japan is still an outlier in all but rheumatology

Interpreting a map

Prescribing factors

Efficacy

Brand comparison shows novel drugs not perceived to be as effective

The ability to predict response is a key unmet need

Remicade leads in terms of speed of action, but this attribute requires further comparative investigation

Side effects

Infection rates and in particular tuberculosis reactivation is of primary concern

Dermatologists consider a drug's effect on child-bearing ability

Immunogenicity divides the brands

Formulary or reimbursement status

DMARDs are considered ineffective for ankylosing spondylitis, but insurance constraints can prevent move to biologics

Time spent on a biologic is limited by cost constraints

Dosing frequency and delivery method

Gastroenterologists consider method of administration important

Brand comparison shows iv Remicade is not well received by dermatologists

Marketing and familiarity

Smarter physician detailing needed

Time on market influences score but is not always the defining pressure

Anti-TNF brand websites provide examples of best practice

Brands with other mechanisms vary their messages

CHAPTER 4 BRAND DYNAMICS

Brand overview

Brand sales trends

Biologic sales overview shows Enbrel leads in terms of total brand sales for all indications

Rheumatoid arthritis underpins total brand sales in 2007

Growth driven by ulcerative colitis and spondyloarthropathies

Brand awareness

Trends in preliminary brand scores by physician type

Rheumatologist

Dermatologist

Gastroenterologist

Brand assessment comparisons

Total score by brand shows future promise for Humira

Interpreting a brand map

Trends in brand scores by country

Brand profiles

Enbrel (etanercept; Amgen, Wyeth)

Enbrel scores close to the average, driven down by dermatologists' opinion

Activation of Crohn's disease with ankylosing spondylitis patients treated with Enbrel

Remicade (infliximab; Centocor, Schering-Plough, Mitsubishi Tanabe)

A fast-acting effective drug but tuberculosis reactivation is an issue

Remicade considered less focused on each specific disease

Humira (adalimumab; Abbott)

Humira's dominance shows as brand scores above average on all factors

Abbott's US co-pay system praised but should be reinforced with dermatologists

Orencia (abatacept; Bristol-Myers Squibb)

Orencia is perceived as the safe option

Rituxan/MabThera (rituximab; Roche, Genentach, Biogen Idec)

Re-treatment data are needed and data from the latest SUNRISE trial should be communicated

Raptiva (efalizumab; Genentech, Xoma, Merck Serono)

Raptiva hit by multifocal leukoencephalopathy side-effect

Amevive (alfacept; Astellas, Biogen Idec)

Amevive's poor efficacy and unusual dosing regime relegate it to last place

Tysabri (natalizumab; Biogen Idec, Elan)

Tysabri recognized by most US and some EU gastroenterologists, but poorly rated by both

Pipeline profiles

Pipeline overview

Licensing opportunities

Pipeline anti-TNFs

The three available anti-TNFs are perceived to be similar, but pipeline anti-TNFs offer little apparent improvement

Cimzia (certolizumab; UCB)

Cimzia administration issues expected to be solved by arthritis approval

Perception of Cimzia is variable

Simponi (golimumab; Centocor, Schering-Plough, Mitsubishi Tanabe, Janssen)

Multiple formulation options do not improve perception

Other pipeline mechanisms

Stelara (ustekinumab; Centocor, Janssen Cilag)

Actemra (tocilizumab; Chugai, Roche)

BIBLIOGRAPHY

Journal papers

Websites

About Datamonitor

About Datamonitor Healthcare

Datamonitor Healthcare's research and analysis methodologies

Datamonitor Healthcare's therapy area capabilities

Disclaimer

List of Tables

Table 1: Physician type surveyed

Table 2: Comparison of physician demographics

Table 3: Characteristics of rheumatologists surveyed across the seven major markets, 2008

Table 4: Characteristics of dermatologists surveyed across the seven major markets, 2008

Table 5: Characteristics of gastroenterologists surveyed across the seven major markets, 2007

Table 6: Attributes assessed by each physician type

Table 7: Anti-TNF prescribing information efficacy comparison across indications

Table 8: Other mechanism prescribing information efficacy data

Table 9: Summary of pros and cons of biomarkers to predict response to TNF therapy

Table 10: Summary of prescribing information black box and major warnings by brand

Table 11: Percent of patients showing positive antibodies against each brand according to prescribing information

Table 12: Formulary prices across the seven major markets, 2008

Table 13: Importance of dosing frequency and delivery method to prescribing of biologics, by country and by physician specialty, %

Table 14: Overview of brand details including mechanism, indications and launch dates

Table 15: Number and percent of physicians able to rate each brand, by country

Table 16: Score given to each brand by attribute, by rheumatologists, 2008

Table 17: Score given to each brand by attribute, by dermatologists, 2008

Table 18: Score given to each brand by attribute, by gastroenterologist, 2007

Table 19: Brand scores by country

Table 20: Enbrel's attribute scores, by country and physician type

Table 21: Remicade's attribute score, by country and physician type

Table 22: Humira's scores by country, attribute and physician type

Table 23: Orencia's scores from rheumatologists by country

Table 24: Rituxan/MabThera's scores, from rheumatologists by country

Table 25: Raptiva's scores by attribute and country, from dermatologists

Table 26: Amevive scores by country and attribute, from dermatologists

Table 27: Tysabri scores by country and attribute, from gastroenterologists

Table 28: Antibody products in clinical trials for autoimmune diseases (rheumatoid arthritis, inflammatory bowel disease, psoriasis)

Table 29: Late stage pipeline product profiles and status by indication and region

Table 30: Cimzia's attribute scores by country and physician type

Table 31: Simponi scores by country and attribute, from rheumatologists

Table 32: Stelara scores by country and attribute, from dermatologists

Table 33: Actemra scores by country and attribute, from rheumatologists

List of Figures

Figure 1: Grouped attribute average importance

Figure 2: Attribute importance, split by physician type

Figure 3: Average attribute importance to prescribing decision for biologic therapies, by country

Figure 4: Importance of grouped attributes to the prescribing decision by physician specialty

Figure 5: Mapping country dynamics with reference to attribute importance, split by physician type

Figure 6: Importance of efficacy factors to prescribing decision for biologic therapies, by country and specialist

Figure 7: Biologic comparative brand scores for efficacy factors, by physician type

Figure 8: Speed of action scores by dermatologists and gastroenterologists, non-weighted

Figure 9: Importance of a good side-effect profile to prescribing decision for biologic therapies, by country and specialist

Figure 10: Importance of formulary and reimbursement status to prescribing decision for biologic therapies, by country and specialist

Figure 11: Brand comparison scores for formulary/reimbursement status, by physician type

Figure 12: Ankylosing spondylitis treatment tree, 2008, seven major markets

Figure 13: Importance of dosing frequency and delivery method to prescribing of biologic, by country and by physician specialty

Figure 14: Brand scores comparison for administration attributes

Figure 15: Importance of marketing and familiarity to prescribing of biologics, by country and by physician specialty

Figure 16: Representation of influences of prescribing

Figure 17: Total representative count, 2003-2007

Figure 18: Brand scores comparison for marketing and familiarity attributes

Figure 19: Time on the market versus score for marketing/familiarity factors

Figure 20: Humira's website messages

Figure 21: Enbrel's directed messages for each indication

Figure 22: Remicade's US website messages

Figure 23: Online marketing for non-TNF mechanisms

Figure 24: Total brand sales for the top autoimmune biologics in the US, five major EU markets and Japan, $m, 2007

Figure 25: Total brand sales across the seven major markets, split by indication, $bn, 2007

Figure 26: Sales growth versus market share by indication for the major biologic brands in the seven major markets, 2004-07

Figure 27: Percentage of physicians able to rate each brand, by country

Figure 28: Sum of score for all attributes, by brand and physician type

Figure 29: Average score for each of the eight comparable attributes, by brand

Figure 30: Overview brand map of attributes versus brand perception by physician specialty

Figure 31: Average weighted brand scores by attribute

Figure 32: Brand scores by country

Figure 33: Enbrel's weighted score compared to average

Figure 34: Enbrel map, country preference to prescribing attributes

Figure 35: Remicade's weighted score compared to the average

Figure 36: Remicade map, country preference to prescribing attributes

Figure 37: Humira's weighted score compared to the average

Figure 38: Humira map, country preference for prescribing attributes

Figure 39: Orencia's weighted scores compared to all physicians average scores and rheumatologists average

Figure 40: Rituxan/MabThera's weighted scores compared to all physicians average scores and rheumatologists average

Figure 41: Raptiva's weighted score compared to all physicians average scores and dermatologists average

Figure 42: Amevive weighted score compared to all physicians average scores and dermatologists average

Figure 43: Tysabri weighted score compared to all physicians average scores and gastroenterologist average

Figure 44: Phase I to pre-registration projects in the pipeline, split by mechanism, 2009

Figure 45: Comparative physician perception of the pipeline and marketed anti-TNF inhibitors

Figure 46: Cimzia's weighted score compared to the average

Figure 47: Cimzia map, country preference for prescribing attributes

Figure 48: Simponi (golimumab) weighted score compared to the average

Figure 49: Stelara's weighted score compared to all physicians' average scores and dermatologists' average

Figure 50: Actemra's weighted score compared to all physicians average scores and rheumatologist average

Abstract

Introduction

Factors influencing a prescribing decision can diverge from clinical facts. In the highly competitive autoimmune area, misconceptions and physician habits can result in loss of sales. Targeted detailing of specialist physicians, differentiating by indications is the key to success. Datamonitor has surveyed gastroenterologists, rheumatologists and dermatologists on attribute and brand perceptions

Scope

• Opinion from 540 physicians including rheumatologists, dermatologists and gastroenterologists
• Data from physicians and opinion leaders across the seven major markets of the US, Japan, France, Germany, Spain, Italy and the UK
• Analysis of the extent to which certain factors affect physician prescribing, with comparison across each specialty
• Analysis of the opinion dynamics for the key brands used across prominent autoimmune diseases

Highlights

Efficacy and safety factors will always be any physician's main consideration, drawing an average of 62% of the weighting by importance when prescribing a biologic therapy. Actemra's positive perception from rheumatologists, despite known side-effects, exemplifies the importance of informing physicians about issues, rather than masking them.

New TNF inhibitors in autoimmune disease battle against 'me-too' status and the strong positive opinion of the existing three products in the category. Humira leads the group with a total score 16% above the average. Newcomer anti-TNF options Simponi (golimumab) and Cimzia (certolizumab) are not well perceived by EU prescribing rheumatologists.

Dermatologists' exhibit cynicism towards biologic therapies, scoring all brands lower than other physician types, less surprising when considering the nature of most psoriasis therapies. However, Centocor's Stelara (ustekinumab) is highly anticipated with dermatologists scoring it 40% above average in terms of predicted efficacy.

Reasons to Purchase

• Target physicians more efficiently by understanding the differences in brand perception between physician specialties
• Tailor your marketing message to the attributes most important to prescribing physicians
• Assess the regional dynamics of physician perception in autoimmune disease across the seven major markets

Please note, this file is delivered as an Zip file.

Get Full Details About This Report >>

About MarketResearch.com
MarketResearch.com is an online aggregator selling over 300,000 market research reports, company profiles and country profiles from over 700 research firms. Our reports will provide you with the critical business and competitive intelligence you need for strategic planning and marketing research. Coverage includes the US, UK, Europe, Asia and global markets.